Abstract

SILVA GODINEZ, Juan Carlos; VASQUEZ CIRIACO, Sergio; JARQUIN ARREMILLA, Arturo  and  VELA MAQUEDA, Paola. The nutritional state does not influence development of anastomotic dehiscence in a Mexican population. Cir. gen [online]. 2013, vol.35, n.1, pp.9-15. ISSN 1405-0099.

Objective: To describe the risk factors associated to the development of an anastomotic dehiscence in patients subjected to intestinal surgery in a Mexican population, emphasizing the nutritional state of the patient. Setting: Surgery Service, Regional High Specialty Hospital of Oaxaca, Mexico. Ministry of Health (Third Level Health Care Center). Design: Clinical, ambispective, ambilective study of cases and controls. Statistical analysis: Univariate analysis with χ², simple binomial logistic regression, and multivariate logistic regression. Patients and methods: We analyzed 144 patients subjected to 214 resections and/or intestinal shunts with anastomoses. We considered different clinical, demographic, and laboratory factors associated to dehiscence of anastomoses. The main risk factors considered were: number of anastomoses, type of anastomoses, IMC, antecedents of cancer, creatinine, smoking, type of surgery, hemoglobin level, leukocytes and lymphocyte counts, clotting time, blood biometrics, gender, intraoperative hypotension, diabetes mellitus, cardiovascular disease, ASA score, hyperbilirubinemia, BUN, surgical bleeding. We assessed the association of these variables with anastomotic dehiscence and mortality in the studied population. Results: We analyzed 144 patients subjected to 214 anastomoses. The univariate analysis revealed that the variables with statistical significance for dehiscence were age (p < 0.001), bleeding (p = 0.01), and need of transfusions (p = 0.03). The presence of hypoalbuminemia or a BMI < 15 was not significant in either the univariate and multivariate analyses. Surgical bleeding and the need of transfusions were the most significant predictors for the development of anastomotic dehiscence in the multivariate analysis (p < 0.01). Conclusions: The presence of hypoalbuminemia and a low BMI does not increase the risk of anastomotic dehiscence in the studied population. The main risk factors associated to anastomotic leakage are transoperative bleeding and administration of hemoderivates during the perioperative time.

Keywords : Malnutrition; dehiscence of anastomosis.

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